Organization
NORTHLAND HEARING CENTERS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY LONGTAIN (PRESIDENT)
(503) 659-5115
Entity
Organization
Contact information
Practice address
5322 N. PORT WASHINGTON RD, GLENDALE, WI 53217-4913
(414) 906-1145
Mailing address
8800 SE SUNNYSIDE RD., STE 210, CLACKAMAS, OR 97015-5738
(503) 659-5115
(503) 659-5887
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
187-12-2O
WI
237700000X
Hearing Instrument Specialist
187-12-2O
WI
Other
Enumeration date
06/26/2012
Last updated
06/26/2012
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